It is as though someone has drilled peep holes into the walls of emergency rooms, operating rooms and doctors' offices. I can't look away.

Thursday, January 10, 2008

I Didn't Know Doctors Really Used Placebos

I should have one of those counters on my blog that reflects how many days I have gone without reading more than 1-2 medblogs a day, except the ones on Bloglines, which aren't as fun because I can't read the comments. A side effect of not reading the medblogs is that I write more, which explains the sudden appearance of more posts on my blog.

One of my favorite Andy Griffith episodes is the one where the new pharmacist (Andy asks her if Ph.G means pharmacy gal) won’t give a little old lady her “medicine” without a prescription. The medicine costs a dime and the lady goes downhill quickly when she can’t get it. Of course, it turns out it was only a sugar pill, the little old lady gets her medicine and everyone lives happily ever after (except for the pharmacy gal, I think Andy must have eventually dumped her for Helen Crump).

I’m supposed to be working tonight, but I stumbled onto this little article by accident and now I can’t let it go. I’ve heard of the “placebo effect” and I know placebos are used in drug studies. I don't doubt the power of a placebo, I was just surprised to learn that, according to this article, doctors really used placebos in the treatment of their patients.

BACKGROUND: The placebo and the placebo effect are often investigated in the context of clinical trials. Little data exist on the use of placebos in the course of routine health care. OBJECTIVE: The aim of this study is to describe a group of academic physicians' use of placebos and their knowledge, attitudes, and beliefs about placebos and the placebo effect. DESIGN: A 16-question anonymous web-based survey of physicians from Internal Medicine departments of 3 Chicago-area medical schools was used. RESULTS: There were 231/466 (50%) physicians who responded; of these, 45% reported they had used a placebo in clinical practice. The most common reasons for placebo use were to calm the patient and as supplemental treatment. Physicians did not widely agree on the definition of a placebo and had a variety of explanations for its mechanism of action. Ninety-six percent of the respondents believed that placebos can have therapeutic effects, and up to 40% of the physicians reported that placebos could benefit patients physiologically for certain health problems. Only 12% of the respondents said that placebo use in routine medical care should be categorically prohibited. Regarding "placebo-like" treatment, 48% of respondents reported giving at least 1 type of treatment in a situation where there was no evidence of clinical efficacy. CONCLUSION: Nearly half of the respondents use placebos in clinical practice and most believe in the mind-body connection. The results of this study, based on retrospective self-reported behavior, are subject to recall bias and may not be representative of American physicians. PMID: 17994270 [PubMed - in process].

I don't know, though. I think I would be pissed if I found out a doctor gave me a placebo, especially if I had to pay more than a dime for it. [What? No one asked me why I would be pissed, since I was "cured"? and, if I were cured, why would cost matter?] So now, instead of researching “lien stripping”, I want to research placebos. If physicians use placebos in their medical practices, then that must mean there is a placebo industry. Do the pharmaceutical companies manufacture placebo pills or does the pharmacist just go to the backroom and break open a box of TicTacs? Is there an official name (or better yet, a secret code name) for placebos, or does the doctor write “sugar pill” in Latin? How much do the pills cost? Or do doctors just hand them out as "samples." Do doctors ever openly admit to prescribing placebos or is this one of those deep dark doctor secrets? What do the medical schools teach about placebos? Can they use Splenda instead of sugar? Liability issues?

11 comments:

I have heard the obecalp word bandied about; back in my gandfather's day, they did indeed write "sugar pill", or "rose water" in latin... or whatever. A prescription then was more a recipe for the apothecary to mix up. I've got an old one somewhere.As for me, I mostly use placebo for non-epileptic seizures (pseudo-fitters)It is amazing how effective a muscle relaxant saline can be, when announced as an anti-convulsant...

I just don't know what I think about all this placebo stuff. I know the mind can do lots of things when given the right prompts, but...... I'm not so sure I'd want to be the one giving the placebo. I just reminds me of a lie.

I've been known to tell patients when giving them their meds, "This is a very strong painkiller. Soon you will have no pain at all," or "This medicine will make you very sleepy, so just relax and sleep comfortably" when giving things that were not terribly strong. I didn't LIE about what I was giving them, I'd tell them the names of the drugs if they asked, but usually they didn't, and usually it works like a charm.

Actually, I thought nurses were specifically prohibited from giving placebos by most state nurse practice acts... I certainly wouldn't feel comfortable giving one, although I have seen a neurologist ask for 1 ml of normal saline and push it to stop a pseudoseizure, although the doc pushed it herself, stating to the patient that it was ativan...

I've never given saline or some nonactive drug in place of a real one; I've just told people that "This is a very strong painkiller" when giving them Toradol, which, while it is strong, is not a narcotic.

Well I go way, way back so I do indeed remember when I got prescriptions for Pil. Sac. Lact. but mostly in homeopathic practices when I was a pharmacist in Britain for a few years.

I was certainly involved in many hospital drug studies over the years which had saline as the non drug containing injectable and lactose inside capsules for the oral non drug containing part.

But obviously there are placebo effects in many of the non traditional medicines, eg. echinacea, where 50 out of 100 people will tell you it helped andthe others say no. No scientific study has ever proven it to be effective.

Me: Damn it, I don't care! This lady is in status epiliticus. If we don't do something she's going to have MASSIVE brain damage from her seizure. This drug is powerful! It has always worked for seizures. I don't care if the gov'mint doesn't approve it!

This sort of technique works well with all sorts of patients who might be exaggerating their symptoms, in my experience. Typically this will be a young male, in Poluce custody, who 'collapsed' shortly after arrest.Clearly, one has to be certain that there isn't genuine pathology, as that's both embarrassing and career ending.Anyway, by announcing loudly that the patient is in extremis and needs brain biopsy / intra-testiculr injection, or they'll die, an amazing recovery is guaranteed...